Provider Demographics
NPI:1275654451
Name:MISRA, SANGHAMITRA (MD)
Entity Type:Individual
Prefix:DR
First Name:SANGHAMITRA
Middle Name:
Last Name:MISRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8080 N STADIUM DR STE 250
Mailing Address - Street 2:MC 6-250
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-1829
Mailing Address - Country:US
Mailing Address - Phone:832-687-6367
Mailing Address - Fax:832-825-6783
Practice Address - Street 1:8080 N STADIUM DR STE 250
Practice Address - Street 2:MC 6-250
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1829
Practice Address - Country:US
Practice Address - Phone:832-687-6367
Practice Address - Fax:832-825-6783
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4885208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX189944501Medicaid
TX189944501Medicaid
TXTXB100005Medicare PIN